Immunization in Children

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Triple Vaccine DPT (Diphtheria, Pertussis, Tetanus)

Von Behring (1913) discovered Diphtheria toxin and the conversation of toxin to toxoid with formalin was independently shown by Remon in Paris and Glennus in the year 1923. Remon and Zodeller developed partially purified toxoid for tetanus in
1927. Inactivated whole cell vaccine against pertussis was developed by Madsen in the year 1923. Protection against diptheria is nearly 90%. Protection against tetanus is almost 95% and lasts life long after primary immunization and booster doses. Protection
against pertussis is much less and is about 70%. Side effects of triple antigen include a febrile reaction, induration at the site of injection and occasionally screaming attacks and encephalopathy, all attributable to the pertussis component.

Pertussis vaccination is contraindicated in children with progressive neurological disease and also further doses are withheld in, children who react with screaming attacks lasting for more than 1 hour after a dose of DPT. For those children, a dual antigen DT is preferred for further immunization. There has always been an element of uncertainty regarding pertussis immunization and encephalopathies. The follow-up system established in Europe and the United States do not indicate a causal relationship and convulsion following immunization is more likely febrile convulsion. DPT is not recommended in children over 6 years of age in view of side effects.

An acellular vaccine containing whole antigen has been developed and found to elicit good antibody response with fewer side effects. It has replaced the classical vaccine in Japan since 1981 with success, with fewer out breaks and less side effects.

Pertussis vaccine is contraindicated with progressive neurologic damage

Withold further doses if screaming attacks > 1 hour occurs after a dose of DPT

Not recommended over 6 years of age.

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